On August 25, 2006, a baby girl was born. I became intimately involved in her life in a way that would lead me to write this story, which I hope will change some minds and ultimately some lives for the better.
As a busy Obstetrician/Gynecologist, I arrived early at work that day. With some 15 patients to see before I was to do a scheduled C-section at 7:00 AM I wanted to make sure everyone got plenty of attention before I was to be unavailable in surgery. One of those 15 patients was Mrs. H, who had delivered her baby girl by emergency C-section during the night and was recovering from her surgery. Most C-sections and recoveries go smoothly, but Mrs. H was coming around more slowly than usual. I had a discussion with her, her husband and her nurse about her situation and how I planned to monitor her closely throughout the day before I went to perform the scheduled C-section.
Despite my best intentions, there was a perfect storm brewing. Being the end of summer, all of the doctors in our large women’s clinic were either out on vacation or off that day save for one who was seeing patients in the office. I was on call for the group which meant that I was responsible for any of the patients in our busy clinic who would happen to go into labor that day or have another issue that needed to be dealt with emergently.
Being a for-profit industry, it was (and still is) the culture in that hospital and clinic to attend to as many patients as possible, seemingly despite the consequences to the health of patients or providers. I had willingly adhered to this cultural standard during my training when I routinely spent 80-100 hours per week at the hospital despite having a new baby at home, two other children and a husband to care for. It didn’t seem to make any difference that the cultural standard was set by men who don’t have the same need to juggle career and family life in the way that women do. We women providers were and are expected to excel at time management while remaining empathetic, compassionate and skillful. I actually embraced this challenge for many years and was considered a compassionate and skillful physician and surgeon.
However, on this day the challenge was to become a struggle, and ultimately a war, as I was notified during the surgery that my patient, Mrs. H, seemed to be taking a turn for the worse. Unfortunately her symptoms were vague and confusing, and didn’t fit any particular diagnosis or recommended mode of action. As I spent a couple minutes pondering her case, I was called to attend to several other patients who also needed my attention.
It was at that moment, while standing outside her door, gazing at her chart, that I was struck by an overwhelming sense of impending doom, along with the realization that I had made the wrong choice in becoming a physician. You see, I knew at that moment that Mrs. H would die from whatever this condition was and that I would be blamed for her death, even if it turned out to be from natural causes. I had seen it happen to other colleagues, who had been accused of “malpractice” in the courts, when they had been compassionate doctors just doing their job to the best of their ability.
On this day, had I been brave enough to speak vehemently on behalf of this patient (and myself) about my need to spend some time taking care of just her, the pain and suffering that ensued upon her death ( later proven to be due to natural causes) might have been lessened. It is a fact of life that mothers die, sometimes in childbirth. Fathers die, babies die, doctors die. Only the heavens know when that day will come for each of us. Physicians need to be able to accept this one fact of “life” if they are to survive their careers. Having personally suffered miscarriages and infertility, I was well acquainted with death and loss, and went into medicine to help people deal with these, especially women facing similar challenging experiences. My patients often told me that I helped them in ways that were beyond what the average doctor was able to, and I treasured this aspect of my career. My ability to assist people as they are going through the great transition of becoming a mother is one of the things that drew me to OB/Gyn.
My sense of impending doom had everything to do with the cultural standard that required me and other doctors to spend as little time with patients as possible so that I could take care of as many people as time would allow, thereby satisfying the projected quarterly income requirements for the institutions I worked for. I realized I was working for the institution and not for the patient, and despite whatever the patient had to say about me or my care, it was the institution that had control over my ability to spend as much time with patients as they required. It was “All About the Money“, and this patient and her family were the red flag that finally convinced me of that fact.
This went against my basic philosophy of “First Do No Harm”, adopted the day I received my Medical degree and recited the Hippocratic Oath. Being restricted from spending time with patients is harmful to both patient and doctor. It resulted ultimately in a great loss for me, the loss of my sense of Compassion. For compassion can be looked upon as another sense, just like our sense of hearing or vision. We need compassion to be able to survive, compassion first for ourselves, and then for others. I lost compassion for the system that would “throw me under the bus” in an effort to dodge blame for this woman’s death, and I lost compassion for myself as I tried in vain to figure out what I had done wrong.
It was one year ago that I became aware that I was suffering from a particularly debilitating case of Compassion Fatigue, a condition caused by combining Burnout with Traumatic Stress. Burnout is caused by living or working in a toxic environment, while traumatic stress is caused by being exposed to traumatic events in one’s own or another’s life. The practice of western medicine (for profit) is very toxic, as providers are discouraged and even legally sanctioned against taking care of themselves. For example, it is difficult to obtain or keep a medical license if one is afflicted with a “mental illness” such as depression or anxiety. When a doctor is sued (and almost all suits are assumed to be due to “malpractice”), it is natural for him or her to become somewhat anxious or depressed about the possible outcome of the suit and question his or her own competence. Furthermore, he or she is prohibited from discussing the situation with anyone, thereby creating isolation when one needs support the most. Medical licensing boards are complicit with the medico-legal system in their zeal to discipline all the “bad doctors” out there, and don’t seem to understand that it is their persecution of good doctors who are traumatized by the system that is making it even more unstable. Add this to the fact that doctors are notoriously bad at seeking help for themselves, and you have a bunch of people who are supposed to be caring for the sick who are sick themselves and totally unaware of it!
The Bottom Line: When you are in this state of mind, it is impossible to think straight!!! You should not be making big decisions for others or yourself, for that matter.
Is this the person you want to take out your appendix?
I feel it is incumbent upon me, as a sufferer of compassion fatigue, to speak up about what is happening to doctors and how it impacts healthcare. Until I fully recover from the symptoms of anxiety and PTSD that I suffer due to my experiences, I am “unfit” to care for others; I am afraid to answer the phone or the door, visit hospitals, doctors offices, attorneys and their offices, or courtrooms, deal with financial documents, legal documents, and mail without anxiety. Lack of empathy and understanding from the medical and legal professions about this condition led me to lose my home, income, career, ability to obtain gainful employment, and valued relationships. It is incumbent upon those who regulate and discipline doctors to understand compassion fatigue and use that understanding to support doctors and help them recover from the effects which include (among others) anxiety, depression, loss of career, homelessness, and suicide, instead of punishing and persecuting those whom they have had a hand in traumatizing.
As for me, I am well on the road to recovery; I found people who love me for who I am and not for my income or medical license, and through self-care I am finding gifts, talents and skills that I never knew I had. Whether I can ever practice medicine again remains to be seen, but for now, I feel like I am finally on the right track.
And although Mrs. H did not live to read this story, her daughter carries on. I believe that everything happens for a reason. If I can help even one person feel less alone in their struggle for adequate health care, whether it be patient or doctor, it will have been worth everything.